4. UTI terminonology
? Uncomplicated UTI :without underlying renal
neurological diseases
? Complicated UTI: with underlying structural , medical
or neurological diseases
5. Diagnosis
? Urine analysis
? Urine culture
Presence of pus cells >8/
HPF , WBCs, RBCs
Bacterial count >1lakh/ml
(significant bacteruria)
Mandatory in men with UTI
6. ED care
? Analgesics
? Uncomplicated UTI
? NITROFURATOIN 100 mg BD x 5days
Or
TMP-SMX 160/800 bd x 5 days
Second line : quinolones x 3 days
? Complicated UTI
depends on culture and sensitivity
Refer to urologist
Admit if fever , severe pain unable to
eat / drink
In pregnancy contraindicated
TMP-SMX
QUINOLONES
Catheterised , start antibiotics
when symptoms present
7. Acute pyelonephritis (pyelum Cnephros-itis)
? Acute pyelonephritis is diagnosed in a patient with a proven urinary
tract infection who has loin pain and/or fever picket fence fever
(Inflammation of kidney and upper urinary tract that result from
bacterial infection of bladder)
8. Causes of acute pyelonephritis
? Vesicoureteral reflux
? Normal urine flow obstruction incomplete bladder emptying
residual urine ascent of infection pyelonephritis
? BPH
Kidney stones
? Catheterisation
? DM
? Loss of neurological control of bladder and spincter
9. Indications for admission with acute
pyelonephritis
? Dehydrated or unable to take oral fluids.
? Evidence of sepsis.
? Pregnancy.
? Failure to improve after 24 hours of antibiotics.
? Abnormal renal tract anatomy or function.
? Pre-existing renal impairment.
? Evidence of renal stones.
? Immunocompromised.
? Diabetes. ¢ Nephrostomy or ureteric catheters
10. ED care
? Antibiotics ！ IV Antibiotics for 7-10 days (guided by local antibiotic
policy).
? Fluid rehydration ！ orally or intravenously.
? Analgesia.
14. ED Care
? Antibiotics ！ a quinolone for 28 days is recommended.
? Analgesia.
? Laxatives if defecation is painful.
? Suprapubic catheterization if in urinary retention (uretheral
catheterization is not recommended due to the risk of disseminating
the infection).
15. Epididymo-orchitis
? Epididymitis is inflammation of the epididymis causing pain and
swelling,
? If testis is involved in the inflammatory process (epididymo-orchitis)
16. Symptoms
? Progressive testicular ache and swelling of the epididymis and testis.
? Low lying testis.
? Tender epididymis.
? Urethral discharge.
? Fever.
18. ED Care
? Antibiotics ！ quinolone (e.g. ciprofloxacin for 10 days), add in
doxycyline if Chlamydia is suspected.
? Patients should be followed up by genito-urinary medicine, if a sexual
transmitted cause is suspected,
? Urology
